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Fat and healthy – not an oxymoron.

Hey there! I know you’re all like “didn’t she say adieu (and spell it incorrectly, too) awhile ago?” Well, I did, but the delightful Powers That Be at Feministe are allowing me to another quick visit, in order to drop some new science on y’all.

So I’m just going to leave this here (along with a small reminder that America’s current conversation surrounding weight and health is shaped, in no small part, by money from the diet industry):

Heavy but healthy? New formula slims down definition of dangerously obese

New Canadian research suggests being obese doesn’t necessarily doom people to an early grave.

Two research teams using a new tool called the Edmonton Obesity Staging System, which ranks overweight and obese people on a five-point scale according to their underlying health, have found that not only can the scale predict who is at greater risk of dying, but that otherwise healthy obese people live as long as those of “normal” weight, and are less likely to die of cardiovascular causes.

The back-to-back studies come as more evidence emerges that a significant proportion of overweight people are metabolically healthy and that the risks associated with obesity do not make for a one-size-fits-all formula.

The Edmonton staging system grades obesity on a scale of zero to four. It uses physical measures such as body mass index, as well as waist-to-hip ratios. But it goes farther by taking into account the presence — or absence — of a spectrum of disease.

Under Stage 0, the person is obese, but has no apparent obesity-related health risks, meaning their blood pressure, blood fats and other risks are all within the normal range. Stage 1 obesity describes people with “sub-clinical” signs of trouble, such as borderline high blood pressure, elevated liver enzymes and occasional aches and pains. Stage 4 is the most severe. At Stage 4, patients have serious, “potentially end-stage” disabilities and illnesses from obesity-related diseases.

In one study published Monday in the Canadian Medical Association Journal, University of Alberta researchers tested the system using data from a survey of 8,143 people in two U.S. national health and nutrition surveys.

They found that although 77 per cent of overweight or obese people in one survey, and 90 per cent of those in another, were classified as Stage 1 or Stage 2, their risk of dying over 20 years of followup was substantially lower than people classified as Stage 3 obesity.

After adjusting for age, history of smoking and metabolic syndrome — a cluster of conditions such as high blood pressure and diabetes —about two per cent of people with scores of O or 1 died during followup, compared to about 40 per cent of Stage 3 patients.

“That’s a huge difference,” said Dr. Arya Sharma, who first proposed the Edmonton classification system.

…

The findings not only challenge the notion that everyone who is obese needs to lose weight. “Just because you’re normal weight doesn’t necessarily mean that you’re healthy,” Kuk said. “You can still have high blood pressure, you can still have diabetes, you can have a poor lifestyle — and all of these contribute to obviously negative health and early mortality risk.”

“You really need to take the emphasis off trying to attain this normal body weight, because lifestyle practices are equally, if not more important.”

“If someone comes to my office and their BMI is 35, they have obesity, there’s no question,” Sharma said.

“But if I do the tests and I find that they have no other risk factors, then I can confidently tell them that they are at extremely low risk of dying. There shouldn’t be an urgent need to lose weight just because their BMI is high. The focus really should be on trying to maintain that weight and not get heavier.”

The opposite could hold for people with lower BMI’s who don’t meet criteria for surgery but who are at high risk and should be treated. “And we’re missing those patients,” Sharma said.

Sharma said people who have a history of weight cycling — losing large amounts of weight only to put the weight back on, or more — appear to be at higher risk of obesity-related complications.

“If you’re constantly dieting and trying to lose weight, and you put it back and you diet again, you might actually be causing problems.”

(all emphasis mine)

To read the whole article as it appeared in the Canadian press yesterday, click here. To read the actual research papers, click on the links embedded above. To read me ranting about some of these issues and the harm they can and do cause, you can click here, or here, or here (or just crawl inside my head, where the rant is on a constant loop).

None of this is new to me – I’ve been reading research building to this for years now – but I’m so glad it’s getting more and more press. Maybe one day soon we will finally have a fat-positive, non-shaming approach. We largely substituted the “fat is bad because it’s ugly” with a faux-gressively PC “fat is bad because it’s unhealthy” argument in the mainstream dialogue, which might almost have been a win in the long run (for all the frustration, angst, and harm it caused), because “unhealthy” is more explicitly disprovable than “ugly”. Maybe some of the “health!” people will turn around and start objecting to fat on aesthetic grounds again (and it’s not like everyone stopped doing that in the first place), but hopefully this will get at least some of the concern trolls off our backs, especially the white-coated ones in medical spaces.

matlun

August 16, 2011 at 11:44 am

I thought it was already established that BMI by itself is a very blunt instrument to predict mortality?

This study only seems to be saying that the “Edmonton Obesity Staging System” is much better at predicting mortality than BMI. Since EOSS is based on a complex evaluation of medical data as opposed to a quick calculation from just weight and length that should surprise absolutely no one.

Christina

August 16, 2011 at 11:59 am

Of course, the ongoing media superscare over obesity rarely considers that people with obesity are anything other than fat, lazy slobs. I mean, just look at ‘normal’ weighted people– two people who physiologically LOOK the same might be a marathon runner or a sit-on-the-couch slob. I mean I’m 5″11 and 125lb but I’m as unfit as can be.

Mike

August 16, 2011 at 1:59 pm

I really don’t agree with the whole “you should lose weight at all costs!” argument. And I totally agree with the goals of HAES.

But this study is REALLY problematic.

The most troubling analysis is accompanying figure 1, where the findings about people with EOSS 0/1 having a lower occurence of cardiovascular disease than those with so-called “normal weight”. Specifically, examine this line:

Normally, when you’re running regression analysis, this is pretty standard when you expect random variation. However, looking at table 2, we see that the group labeled EOSS 0/1 was 5 times more likely to have low fitness levels! (8.2% of the population compared with 46.83%) This is obviously non-random yet it was “controlled for” meaning that its effect ignored in the final analysis.

If there is a known connection between low cardiovascular fitness and cardiovascular disease, and if there is also a known correlation between being EOSS 0/1 and having a low level of cardiovascular fitness, then there actually IS a link between being categorized as EOSS 0/1 and having an increased risk of cardiovascular disease, but it is a link the researchers are willfully ignoring through their choice of statistical techniques.

As they do not publish their full regression results, it is impossible to be sure how strong this link is, but this does seem to be a significant problem.

Note: BMI is still a totally crap indicator, but that’s no excuse to accept junk science.

shah8

August 16, 2011 at 6:31 pm

I saw that right away, too, Mike. I didn’t pay that much mind to it, since the overall goal is getting people to live healthier lives and health professionals to do a better job of measuring actual health instead of using cheap heuristics.

It’s just that the politics are so narfy, I don’t particularly want to talk about it, and I suspect many others are the same. People insist that a complex topic should be simple, when it’s just not.

As far as fat as a personal issue goes? Health is a lifestyle set of choices. You can’t make the decision to exercise unless you will stick to it for a lifetime. Same with dietary choices. You do what you can do (if you have a stable enough life with access to resources), and let other people mind how you look. They care about it because they want to see themselves as better than you. Eff all that. Just get into a rhythm you can sustain, diet and exercise wise (with input from your own body and your doctor/dietitian), and you will get health benefits, even if it’s invisible in the mirror. It’s hard to do the profoundly simple, but that makes it all the more important to remove distracting complexity from what your choices really are.

In other news, if there’s utterly zero indication that anything weight related is going to kill me — my weight is probably not going to kill me?

Jackie

August 17, 2011 at 1:18 am

Glad to see the doctors in Canada are focusing on health, and not the money they receive from insurance companies. Hopefully America will wake up, and realize the days of headless fat people on the news and shaming should be over.

rae

August 21, 2011 at 8:11 pm

Mike –

But controlling for fitness level allows us to separate whether health problems are actually caused by the obesity itself or if weight correlates to poor health outcomes because both of those two variables are related to fitness levels. These results show that doctors should not be measuring weight, which is sometimes an indicator of fitness level but also is often not a problem at all, and instead should be measuring fitness levels. It’s validation that if you are, say, a 200+ lb woman who works out for 45 minutes every day yet never seems to lose a pound, your weight is not independently a problem.